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Medication Lookup
The results below have been sorted using a 2-tier plan. For the most accurate search results, check your plan details and choose another tier plan from the drop-down menu near the search bar.
15.75MG NASAL SPRAY
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Note TitleNon-Opiate MedicationDefinitionThis medication is a non-opiate product. You can use this medication for pain management instead of using opioid-based medications.
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Note TitleExceptions To Non Covered MedicationsDefinitionYour doctor may submit a request for an exception. If approved, the medication must still follow any applicable requirements before it can be covered by your plan. You’ll also pay the highest tier cost.
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Note TitleNot Available Through Mail ServiceDefinitionThis medication is not available through the mail service pharmacy
Prior Authorization Forms
Massachusetts Standard Form for Hepatitis-C Medication Prior Authorization Requests
Massachusetts Standard Form for Medication Prior Authorization Requests
Massachusetts Standard Form for Synagis® Medication Prior Authorization Requests
Important Information
Affordable Care Act (ACA) Medication List
Medical Benefit Prior Authorization Medication List
Over-the-Counter Exclusion Medication List
Quality Care Dosing Guidelines
Learn About Your Pharmacy Program
Learn About Your Pharmacy Program
Affordable Care Act (ACA) Medication List
Cost-Share Assistance Program Medication List
Health Savings Account (HSA) Preventive Medication List
Lower-Cost, Brand-Name Insulins Medication List
Medical Benefit Prior Authorization Medication List
No-Cost Generic Medications List
Over-the-Counter Exclusion Medication List
Specialty Pharmacy
Specialty Pharmacy Medication List
5-Tier Specialty Pharmacy Medication List
6-Tier Specialty Pharmacy Medication List
Alternatives to Opioids
For Federal Employee Program Members
Eligible Medicare Members
- KETOROLAC TROMETHAMINE
- TRAMADOL ER TABLETS
- ACETAMINOPHEN/CODEINE
- HYDROCODONE/ACETAMINOPHEN
- TRAMADOL 50MG
- TRAMADOL/ACETAMINOPHEN
- CELECOXIB
- DICLOFENAC POTASSIUM
- DICLOFENAC SODIUM DR
- DICLOFENAC SODIUM EC
- DICLOFENAC SODIUM ER
- DIFLUNISAL
- ETODOLAC
- ETODOLAC ER
- FENOPROFEN TABLETS
- FLURBIPROFEN
- IBUPROFEN
- INDOMETHACIN
- KETOPROFEN ER
- KETOPROFEN 50MG
- KETOPROFEN 75MG
- MELOXICAM
- NAPROXEN
- NAPROXEN CR
- PIROXICAM
- SULINDAC